Provider Demographics
NPI:1033627179
Name:GREATER FRESNO HEALTH ORGANIZATION, INC.
Entity Type:Organization
Organization Name:GREATER FRESNO HEALTH ORGANIZATION, INC.
Other - Org Name:CEDAR UNIVERSITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUANOUTOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-255-6476
Mailing Address - Street 1:4770 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1065
Mailing Address - Country:US
Mailing Address - Phone:559-860-4900
Mailing Address - Fax:559-255-7906
Practice Address - Street 1:4770 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1065
Practice Address - Country:US
Practice Address - Phone:559-860-4900
Practice Address - Fax:559-255-7906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER FRESNO HEALTH ORGANIZATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health